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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT RE UEST <br />Butala Construction Company t/ <br />M-1987-127 <br />Butala Pit <br />May 11, 2009 <br />$323.00 (Due on or before your anniversary date) <br />Chaffee <br />J <br />Wy 0 4 Z00'9 <br />®iei?ima? ens ;; =e,:rnation, <br />RECEIVED <br />MAY 0 4 200,q t-? <br />Di?'lsio.r of kec -rnation, /j? <br />M;chzg and Safety ' f; <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />-, during the upcoming year, reclamation that will -be performed -duringthe cbming-year, the dat-eg r the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. The Annual Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new may is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />above elements may since for a written report. <br />Division records indicate the following .permittee contact information. Please verify and make any necessary. <br />changes: <br />Permittee Contact: Frank Butala <br />Permittee Name: Butala Construction Company <br />Address: 9000 CR 152 <br />P.O. Box 907 <br />Salida, CO 81201-9519 <br />Phone Number: (719) 539-2521 <br />Fax Number: -- - (719)539-2523 __ <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />C <br />Signa e of Corporate Officer, Owner, or Designee <br />? v <br />Date